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In June 2023, Illinois Department of Healthcare and Family Services (HFS) announced emergency rules that, among other changes, would allow medical providers to collect co-payments and co-insurance from individuals enrolled in Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) Programs. On September 5, 2023, however, HFS issued a new provider notice stipulating that, until further notice, no provider should be charging co-payments or co-insurance to individuals enrolled in Health Benefits for Immigrant Seniors (HBIS) or Health Benefits for Immigrant Adults (HBIA). In addition, medical providers are also required to return any cost-sharing that has already been collected to the customer.
Background
HBIA and HBIS are state-funded programs that provide health care to Illinois residents who do not meet the requirements for federally funded Medicaid due to immigration status. On July 1, 2023, enrollment into HBIA was paused under emergency rules passed to ensure that healthcare reimbursement costs do not exceed allocated budget for the program. Additionally, the rules imposed a cost-sharing structure of co-pays and co-insurance for inpatient hospitalizations, hospital emergency room visits, and hospital and ambulatory surgical center outpatient services. Please view the Avisery alert regarding this announcement here.
Avisery is aware that many providers had refrained from implementing any copays while awaiting further HFS guidance on how to utilize these new cost-sharing mechanisms. On September 5, however, HFS sent a new notice that providers should refrain from charging any co-pays or co-insurance at this time until HFS updates their systems to be able to deduct any patient cost sharing from provider reimbursements. Until further notice, therefore, hospitals and medical providers should not collect co-pays or co-insurance from individuals covered under HBIS and HBIA. If you are or become aware of any HBIA/HBIS enrollees who were charged these cost-sharing fees as of July 1, 2023, please encourage them to seek reimbursement from their provider.
Reminder: HBIS Enrollment Still Open
Please be aware that enrollment is still open for HBIS until the cap of 16,500 enrollees is reached. As of early September, there are approximately 15,500 enrollees in the program. HFS has committed to advocates that they will give a 14-calendar day notice before enrollment is closed. Under HBIS, Illinois residents who are 65 years old or older, a lawful permanent resident (green card) for less than five years or an undocumented immigrant, and who meet income and asset limits are eligible for health coverage. Please follow this link for details about covered medical services and eligibility.
As always, If you have any questions, please feel free to email us at avisery@ageoptions.org or call 708.628.3440.
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